Managing complex responsibilities is a common task for digital leaders. However, for Erik Mayer, transformation chief clinical information officer (CCIO) at Imperial College London and Imperial College Healthcare NHS Trust, the mix of responsibilities is central to his role.
He spends about 40% of his time in the clinic and the rest helping to define the future of digital healthcare.
“I enjoy both roles because, actually, they should be intertwined,” he says. “I have many conversations with clinical and academic colleagues who say, ‘Can I get access to this data?’ That’s why it should be intertwined, because what you put in is what you get out.”
Mayer’s successful transition from the surgery room to the IT department began during his PhD research from 2006 to 2009, when he analysed data to produce evidence for centralising cancer services and improving patient care. Through his role at the trust, he became involved in technology implementation projects.
“I’ve always been in and around data and producing robust evidence for why we should or shouldn’t do things,” he says.
“Then, at Imperial Trust, I was a surgical trainee and became involved in IT, informatics and data warehouse-type environments. I was heavily involved in the work when we went live with the Cerner electronic patient record in 2014.”
As Mayer’s experience grew, so did the opportunities to move into new areas. In 2018, after a competitive process, he was appointed to his current role. He has continued to expand his compass while working on the healthcare frontline.
“I wanted to be forward-thinking about creating secure environments to support access to data for driving research and innovation,” he says.
“I wear many hats. I’m a practising surgeon, transformation CCIO, clinical social professor in Imperial College, and I head up the directorate of the iCARE Secure Data Environment (SDE), which is a digital collaboration space that spans the university and the trust.”
Fostering collaboration
Looking back on his seven years in the CCIO role, Mayer says the data environment has evolved into today’s cloud-based platform using Microsoft Azure and Snowflake technology. He says the transformation process was accelerated during the coronavirus pandemic.
“We’d already set up the environment and had some exemplar projects going on where we were supporting healthcare delivery in the trust,” he says.
“Then Covid hit and, suddenly, there was a huge appetite and urgency about accessing data to support basic decision-making around operational processes.”
These processes included monitoring the number of people with the virus and moving patients around the hospital to free up intensive care beds. Through a collaboration with the North West London Integrated Care Board, Mayer and his peers brought together two key datasets, making it possible to track trends across 2.8 million people.
“I wear many hats. I’m a practising surgeon, transformation CCIO, clinical social professor in Imperial College, and I head up the directorate of the iCARE Secure Data Environment”
Erik Mayer, Imperial College Healthcare NHS Trust
“That created a burning platform for data,” he says, looking back on the interest in information that this initiative helped to foster for the longer term. “Today, that data is now fully migrated and held in the same secure environment as the Imperial Trust data, as well as other databases across different tendencies.”
Mayer says having all these databases together in a secure data environment makes it easier for people to link insights. This capability has changed the mindset of people using data. Previously, particularly in the academic world, people and organisations had to set up data-sharing agreements. Now, collaboration is fast becoming the standard way of working.
“This project brought people into the data environment to do their research and innovation. That approach brought academics together with clinicians and data scientists, meaning we could get quick answers around risk prediction and other insights,” he says.
“Our digital transformation was about bringing the right multidisciplinary people together to work collaboratively in a secure way. Fundamentally, of course, by doing that, you maintain the public trust because you’re not selling data off or moving it around.”
Integrating data
Mayer says the implementation of Snowflake technology has been a crucial component of his data-led approach to digital transformation. While it took weeks to ingest data using previous legacy architectures, the Snowflake AI Data Cloud enables data ingestion in days, supporting the work of healthcare professionals in various roles in a secure environment.
“A lot of the projects are research, but we also focus on direct care,” he says. “So, for example, there are several dashboards that are supporting our clinicians in understanding patients and high-risk cohorts. So it’s direct care research, but it’s also about operational decision-making and efficiencies.”
Our digital transformation was about bringing the right multidisciplinary people together to work collaboratively in a secure way Erik Mayer, Imperial College Healthcare NHS Trust
The organisation is also tapping into the Snowflake Marketplace, an online platform where users source third-party data for its use in the AI Data Cloud. Through the marketplace, research and clinical teams have access to additional non-health data for research and clinical care. Potential sources include Ordnance Survey and the Met Office.
“This is an interesting area for us,” says Mayer, referring to the use of marketplace data. “We’re just starting on this journey. With some of the data, for example, you can start to understand where people live, what services they’re accessing, and why.”
This in-depth detail will be crucial as organisations attempt to support the long-term vision of the NHS 10-year health plan for neighbourhood-based healthcare services.
“You have the evidence to show what is happening, so you can start to plan better,” he says. “Bringing together data is now a way to help us support hospitals and the community.”
Mayer and his colleagues are exploring other ways to exploit the platform. One key use case is federation, including how other trusts in north-west London can share primary and secondary care data. Another use case is artificial intelligence (AI). The data team’s AI testbed in its SDE is supported by Snowflake and Accenture, with secure access to Microsoft AI services and models.
“If you can leave the source data in the separate SDEs and then federate to allow algorithms to run across those sources, you’re not duplicating the cost and resources,” he says.
“So, that’s the piece we’re just developing across environments, which will support, again, operational efficiency, direct care and, of course, research.”
Supporting change
Mayer recognises that his data team’s efforts resonate with the NHS digital plan and its focus on key areas, such as federation and single patient records. This plan aims to create a digitally enabled and integrated healthcare system.
“The interoperability piece for sharing information on individual patients across healthcare providers is critical,” he says. “Just in terms of time savings, you’re not having to sit there trying to understand what’s happened so far – it’s all linked up. And I’m seeing that in my practice now, it’s happening. That kind of federation is a game-changer.”
From a research perspective, Mayer says one crucial initiative is the Health Data Research Service scheme, which aims to create a single, secure UK-wide access point for national health data. Across both clinical and research settings, the key to success is building strong foundations for change. Mayer points to critical projects, such as the NHS England Data for Research and Development Programme’s attempts to create a national network of SDEs.
“These initiatives have gone a long way already to providing a front door for access to data with an explanation around what it is, the clinical definitions and the metadata,” he says.
“We don’t need to reinvent the wheel. We need to build on what we’ve got so far, because that effort has been developing well over the last three or four years.”
This progress includes work in his own organisation. “Within the iCARE SDE, we have built the London analytics platform,” he says.
“We are one half of the London Secure Data Environment, so we are providing that architecture, and the data will start flowing soon. This effort is not just about our trust. It’s a framework that will support the national agenda.”
The NHS has a chequered history when it comes to IT initiatives. However, Mayer says the progress that’s been made recently in data-led projects is impressive. While digital transformation across large-scale organisations can be a challenging process, he’s positive about the opportunities ahead for UK healthcare.
“Now, I think there’s a requirement for a careful thought piece around how local NHS trusts fund, resource and keep up with change, and thinking about business intelligence units, and how those areas start to shape up,” he says.
Leading transformation
Mayer reflects on the pace of change. He suggests the speed of transformation continues to quicken and that AI will play a crucial role in the future of healthcare.
From optimising schedules to reducing the administrative burden by automating clinician note-taking, emerging technologies can have a big impact. However, the key to success is identifying the right, trusted technological solutions for the business challenges.
“We need to think about the problem and the opportunity, and then look at the technology to support us, as opposed to going, ‘AI is going to solve everything’,” he says.
“We’ve got to maintain the public trust around this transformation. They’re starting to engage with these technologies, so we must consider the digital literacy piece.”
This rapid pace of change can bring new and unexpected challenges to healthcare technologists. Mayer says effective digital leaders will develop professional resilience and respect by building a sense of social capital.
“It’s about being clear about the benefits and impact of what everyone’s doing as a multi-disciplinary team,” he says. “Our team includes data engineers, data scientists, clinicians and nurses. If they can feel, metaphorically, the impact and see the effect on care delivery, then they know they’re making a difference.”
Mayer says those results also inspire him. “As a leader, I see that impact, and that’s what gets me out of bed every day,” he says. “Essentially, successful delivery is about that team environment – it’s having a clear message and clear social capital where you say, ‘This is what we’re trying to do and why’.”
